Psychiatric diagnoses in older people with intellectual disability in comparison with the general population: a register study

• Published in: Epidemiology and psychiatric sciences Vol. 27; no. 5; pp. 479 - 491
• Main Authors: Axmon, A., Björne, P., Nylander, L., Ahlström, G.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.10.2018
• Subjects: Affective disorders; Age; Aged; Aged, 80 and over; Alcohol; Alcoholic beverages; Annan medicin och hälsovetenskap; Anxiety; Anxiety Disorders - diagnosis; Anxiety Disorders - epidemiology; Attention deficit hyperactivity disorder; Behavior disorders; Clinical Medicine; Cohort Studies; Data collection; Dementia; Dementia disorders; Diagnosis; Drug abuse; elderly; Ethics; Female; Geriatric psychiatry; Gerontologi, medicinsk/hälsovetenskaplig inriktning; Gerontology, specializing in Medical and Health Sciences; Humans; Intellectual disabilities; Intellectual Disability - diagnosis; Klinisk medicin; Male; Medical and Health Sciences; Medical diagnosis; Medicin och hälsovetenskap; Mental disorders; Mental Disorders - diagnosis; Mental Disorders - epidemiology; Mental Disorders - psychology; mental health; mental retardation; Middle Aged; Mood Disorders - diagnosis; Mood Disorders - epidemiology; Older people; Original; Original Articles; Other Medical Sciences; Population; Population studies; Prevalence; Primary care; Psychiatry; Psychosis; Psychotic Disorders - diagnosis; Psychotic Disorders - epidemiology; Psykiatri; Registries; Review boards; Schizophrenia; Sweden - epidemiology; Sweden; mental retardation; Diagnosis; elderly; mental health
• ISSN: 2045-7960; 2045-7979
• DOI: 10.1017/S2045796017000051

To describe the occurrence of psychiatric diagnoses in a specialist care setting in older people with intellectual disability (ID) in relation to those found in the same age group in the general population. A cohort of people with ID (n = 7936), aged 55 years or more in 2012, was identified, as was an age and sex-matched cohort from the general population (n = 7936). Information regarding psychiatric diagnoses during 2002-2012 was collected from the National Patient Register, which contains records from all inpatient care episodes and outpatient specialist visits in Sweden. The mean age at the start of data collection (i.e. January 1st, 2002) was 53 years (range 44-85 years). Seventeen per cent (n = 1382) of the people in the ID cohort had at least one psychiatric diagnosis recorded during the study period. The corresponding number in the general population cohort was 10% (n = 817), which translates to an odds ratio (OR) of 1.84. The diagnoses recorded for the largest number of people in the ID cohort were 'other' (i.e. not included in any of the diagnostic groups) psychiatric diagnoses (10% of the cohort had at least one such diagnosis recorded) and affective disorders (7%). In the general population cohort, the most common diagnoses were affective disorders (4%) and alcohol/substance-abuse-related disorders (4%). An increased odds of having at least one diagnosis was found for all investigated diagnoses except for alcohol/substance-abuse-related disorders (OR = 0.56). The highest odds for the ID cohort was found for diagnosis of psychotic disorder (OR = 10.4) followed by attention deficit/hyperactive disorder (OR = 3.81), dementia (OR = 2.71), personality disorder (OR = 2.67), affective disorder (OR = 1.74) and anxiety disorder (OR = 1.36). People with ID also had an increased odds of psychiatric diagnoses not included in any of these groups (OR = 8.02). The percentage of people with ID who had at least one diagnosis recorded during the study period decreased from more than 30% among those aged 55-59 years in 2012 (i.e. born 1953-1957) to approximately 20% among those aged 75+ years in 2012 (i.e. born in or before 1937). Older people with ID seem to be more likely to have psychiatric diagnoses in inpatient or outpatient specialist care than their peers in the general population. If this is an effect of different disorder prevalence, diagnostic difficulties or differences in health care availability remains unknown. More research is needed to understand the diagnostic and treatment challenges of psychiatric disorders in this vulnerable group.